PP-131 Cochlear Implantation in a Patient with Cardiac Pacemaker: Electromagnetic İnterference?

MARCH 26e29, 2015 junctional bradycardia and regained consciousness. Short-term of second degree atrioventricular block was observed before normal sinus rhythm. Dual-chamber pacemaker with rate drop response was implanted to the patient. His further clinical course was uneventful. Conclusions: Prolonged asystole during HUT has been proposed to identify a distinct subgroup of patients with neurocardiogenic syncope. Management including permanent pacemaker implantation might be performed for prevention of syncope. Physicians should be aware of potential complications such as prolonged asystole during HUT.

- PP-129 An Unusual Pacemaker Syndrome Case: Recurrent Pericardial Tamponade. Serkan Yakan, Nihat Pekel, Mehmet Emre Ozpelit, Istemihan Tengiz. Department of Cardiology, Izmir Univercity, Izmir, Turkey.

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Introduction: Pacemaker syndrome is an atrioventricular dyssynchrony resulting from concurrent contractions of the atria and ventricules due to retrograde ventriculoatrial conduction. So far, pericardial effusion due to pacemaker syndrome is not reported in the literature. Case: 61 year-old male having CABG and VVI-ICD implanted after MI was admitted with dyspnea. Echocardiography and tomography showed pericardial tamponade (figure d). EF was 35 %. 1150 ml. serous pericardial effusion was drained. The patient was readmitted with dyspnea 45 days later. Pericardial tamponade was seen with echocardiography (figure e-f) and effusion was drained. Electrocardiography showed pacemaker rhythm with atrial activity consistant with retrograde p waves (figure a ). Pacemaker lower rate was reduced to 40 and sinus ritm at 44/minutes appeared. He was readmitted 20 months later. Echocardiography showed pericardial effusion and tamponade( fig g). ECG showed ventricular pacemaker rhythm at the rate of 45 (figure b ). Pericardial effusion was drained (figure h). Pacemaker lower rate was reduced to 30 beats/minute and a sinus rate with a rate of 37 beats/ minute appeared (figure b ). Patients was thought to have pacemaker syndrome due to retrograde ventriculoatrial conduction. EPS showed retrograde conduction over Atrioventricular node. Amiodarone was causing bradycardia and stopped. After 4 mounths, rhythm was sinus, no pericardial effusion was present (figure c-i). Discussion: Pacemaker syndrome is a cluster of signs and symptoms in ventricular-based pacing systems due to retrograde ventriculoatrial conduction causing concurrent atrial and ventricular contractions. Restoration of atrioventricular synchrony causes full recovery of the disease. First ECG shows competition between sinus node and

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pacemaker, and retrograde p wave causing a notch in ventricular pacing stimulation QRS is seen. At the second pericardiosynthesis, ECG shows complete ventricular pacing and atrial potentials were seen. Lower rate was decreased and sinus rhythm with a rate at 44 beats is achieved which causes patient to have 20 months without symptoms. When the pericardial effusion recurs, rhytym was again ventricular pacing with retrograde atrial activity. Sinus rhythm was seen with a rate of 37 when lower pacing rate was reduced, and rate increased gradually till 70 after stopping amiodarone. Result: This was a pericardial tamponade case due to pacemaker syndrome, in which the relation between ventricular pacing rhythm and pericardial effusion is clearly demonstrated. As far as we know, this is the first case in the literature.

- PP-130 The Isolation Time of Pulmonary Vein after Cryoablation for Atrial Fibrillation: Is There Any Prognostic Value? Aziz Inan Celik, Caglar Emre Caglıyan, Onur Sinan Deveci, Ali Deniz, Rabia Eker Akıllı, Mustafa Gök, Muhammet Bugra Karaaslan, Mustafa Tangalay, Aslıgül Cureoglu, Müslüm Fırat Ikikardes, Mesut Demir, Mehmet Kanadas¸ı. Çukurova University Faculty of Medicine Department of Cardiology. Objective: Atrial fibrillation (AF) is one of the leading health problems in the modern era. Cryoablation therapy is an effective and safe method for the management of AF. However, recurrence of AF is still a major problem. In this study, we aimed to investigate the association between pulmonary venous isolation (PVI) time and recurrence of AF. Methods: Patients undergoing successful cryoablation for AF at Çukurova University Cardiology Department were included in our study. Patients, who showed no obvious pulmonary venous potential in at least one of the pulmonary veins were excluded. Mean PVI time (PVPD time/ number of pulmonary veins with potential), total cryoablation time (CAT) and CAT/PVI time ratio were calculated. Patients were followed up for at least 6 months. Recurrence of AF was described as occurrence of clinical AF or detection of at least 30 seconds of AF episode on event recorder. Comparison of two groups was performed by Mann-Whitney-U test. Results: A total of 23 patients had undergone cryoablation. Since venous potentials were not observed in 3 of them, 20 patients were included in our study. Recurrence was observed in 6 patients (30 %). PVI time was shorter in patients with recurrence (48.7
20.3 vs 62.9
21.7 sec; p¼0.312). Total CAT/PVI time ratio was significantly higher in patients with AF recurrence (12.1
5.2 vs 7.2
2.5; p¼0.041). Conclusion: During the cryoablation procedure, providing a fast pulmonary isolation could be a factor for predicting acute success but this parameter does not seem to carry prognostic value for recurrent cases. The limitation of our study is the sample size is limited to make definitive concerns. Further well-organized studies with large patient size are required for more precise results.

- PP-131 Cochlear Implantation in a Patient with Cardiac _ Pacemaker: Electromagnetic Interference?. Mustafa Remzi Karaoguz, Sinan Altan Kocaman, Oben Baysan, Mehmet Emin Korkmaz. Ankara Guven Hospital, Department of Cardiology, Ankara, Turkey.

Figure. Electrocardiographic and Echocardiographic Appearance of the Patient.

Nowadays, increasing medical device applications by developing technology find different places in current era of medicine. Even though these devices have proven themselves in the treatment of a specific disease, we have less information about possible interactions of different devices when used in a same patient. In this report, we present the electromagnetic interactions between a cochlear implant and

S154 The American Journal of Cardiologyâ MARCH 26e29, 2015 11th INTERNATIONAL CONGRESS OF UPDATE IN CARDIOLOGY AND CARDIOVASCULAR SURGERY ABSTRACTS / Poster

MARCH 26e29, 2015

- PP-132 Eversion and Conventional Carotid Endarterectomy Techniques in Terms of a Comparison of Hypertension. Haydar Yas¸a1, Muhammed Akyuz2, Barcın Ozcem4, Mehmet Bademci3, Nihan Karakas3, Banu Akdag Lafcı3, Tayfun Goktogan3, Ali Gurbuz3. 1Batı Anadolu Central Hospital; 2Ege University; 3Katip Celebi University Ataturk Training And Research Hospital; 4Near East University Faculty Of Medicine.

Figure. On the day of cochlear implantation, inappropriate atrial and ventricular sensing. Ventricular rate was detected to be 380 beats per minute.

a previously implanted cardiac pacemaker.We present our experience with cochlear implantation in a 51-year-old male patient who had a DDD mode cardiac PM (Boston Scientific, ALTURA 20 S203 DR) implanted three years ago because of complete atrioventricular block. Due to hearing problems, 3 months ago a cochlear implant (MAESTRO Cochlear Implant System from MED-EL) has been fitted on the same side of the body with the pacemaker. The patient was admitted to our outpatient clinic for PM control. Following PM generator interrogation, we revealed inappropriate atrial and ventricular sensing events at the day cochlear implantation (Fig. 1). The device had detected ventricular tachycardia inappropriately. His surface electrocardiogram showed atrial sensing-ventricular pacing (As-Vp) rhythm. Left lateral and chest radiography demonstrated normally located cardiac PM and cochlear implant. A 24-hour Holter monitoring was performed which showed no clue for any interaction. After the patient connected to the Pacing System Analyzer again, possible interactions were investigated by reducing the atrial and ventricular sensitivity to the maximum levels (Atrial sensing to 0.5mV vs ventricular sensing to 1.5mV). There was no unusual situation. The external part of the cochlear implant in the upper outer side of pinna was at a distance of 22 cm from the PM battery. When the mobile external part of cochlear implant was approximated to the pacemaker, PM converted to the magnet rhythm at a 3 cm of distance. In the light of this case’s information, we think to be appropriate to convert a DDD pacemaker to DOO/VOO mode in pacemaker-dependent patients during the implantation of cochlear device. Bipolar electrosurgical instruments may also be suitable for PMs. Apart from this measures unless the external part of cochlear implant is placed over the PM battery, an additional electromagnetic interaction does not take place and simultaneous usage of two devices in the same patient were determined to be safe. In a patient with a preexisting cochlear implant, if insertion of a new cardiac pacemaker is needed, selection of the other side may be a suitable option.

Peripheral Interventions: Imaging in Diagnosis (Abstract nos. PP-132 w PP-142)

Background: The role of carotid endarterectomy for the treatment of carotid bifurcation atherosclerosis is now well established. The operative procedures for carotid stenosis, the eversion techniques require an oblique circumferential incision of the internal carotid artery (ICA) at the carotid bulb and transection of the carotid sinus nerve fibers. In this study, the incidence of postoperative hypertension (HTN) after eversion carotid endarterectomy (E-CEA) was compared with conventional carotid endarterectomy (C-CEA) in the short- and mid-term follow-up periods. Methods: Baseline blood pressures were recorded in all patients 1-2 weeks before the CEA. Systolic blood pressure values and diastolic blood pressure values were <¼ 140 mmHg and <¼ 90 mm Hg respectively. The patients with a history of hypertension, antihypertensive medication, uncontrolled hypertension in the preoperative period, severe bilateral atherosclerotic lesions and CEA, and the patients that suffer from mortality and morbidity during the follow-up period were excluded from the study. Postoperative follow-up of patients with hypertension in the first, sixth, and twelfth months were recorded by outpatient visits, phone calls, and home visits. A total of 164 patients were included in the study ( E-CEA¼76, C-CEA¼88). Results: The mean age was 67. 3
13.4 years in the E-CEA group and 64.8
14.8 years in the C-CEA group. Mean cross clamp time was 7.54
4.6 minutes in the E-CEA group and 9.62
3.7 minutes in the C-CEA group (p¼ 0.236). One month after the operation, patients in the E-CEA group had significantly (P <.005) higher mean peak systolic, diastolic, and mean blood pressures than those in C-CEA group. In the sixth and twelfth postoperative month, there was no significant difference between the two groups in terms of hypertension (P>¼.078). The number of patients that had continued administeration of antihypertensive agents were, 4 (5.2%) and 3(3.4%) in the E-CEA group and C-CEA group, respectively. Normalization of arterial blood pressure was achieved in the other patients. No significant postoperative neurological, surgical, or cardiac complications developed in any patient in either group. Conclusion: As a result, the researchers suggest that there is no difference between the two groups after E-CEA control of hypertension at the early and middle periods.

- PP-133 Aortic Arch Interruption Always Needs Surgical Approach: A Case of Angioplasty and Stenting in a 20 Years Old Man. Atila Iyisoy1, Cengiz Ozturk1, Sevket Balta2, Mustafa Aparci3, Mustafa Demir1, Sait Demirkol1, Murat Unlu1, Uygar Cagdas Yuksel1, Turgay Celik1, Ali Osman Yildirim1. 1Department of Cardiology, Gulhane Medical Faculty, Ankara, Turkey; 2 Department of Cardiology, Eskisehir Military Hospital, Eskisehir, Turkey; 3Department of Cardiology, Kasımpasa Military Hospital, Istanbul, Turkey. A 20-year-old man was referred to our outpatient clinic for evaluation of arterial hypertension and claudicatio intermittant complaints. In physical examination, the arterial blood pressure was 190/90 mmHg in both arms. Although the pulses were equal over both upper extremities significant radial-femoral delay was noted. The bilateral femoral and popliteal pulses

The American Journal of Cardiologyâ MARCH 26e29, 2015 11th INTERNATIONAL CONGRESS OF UPDATE IN CARDIOLOGY AND CARDIOVASCULAR SURGERY ABSTRACTS / Poster S155

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